Making everyone happy is impossible. Pissing them off is a piece of cake. I like cake.

Monday, September 15, 2008

Slimmin' Withoot Wimmin

That is, in fact, the name of a men-only weight loss scheme in Ayrshire, apparently. I nearly giggled at the name because it's pretty fucking funny embodying, as it does, a number of ridiculous Scottish clichés. So here's another one: to most Scotsmen, slimmin' withoot wimmin means being in a pub and having a triple vodka with diet coke.

There are occasions - not many, admittedly, but occasions nonetheless - when even hyperventilating, loony bloggertarians like myself have to stand back in silent astonishment, mouths agape, and admit that the sheer pace of state nannification is leaving cheap satire in the blocks. Consider this, for example:

A team of NHS nurses is patrolling Scotland's streets to target pot-bellied members of the public and tell them how to lose weight.

Armed with measuring tapes to check waists and equipment to test blood pressure, the "Street Nurses" are policing busy shopping centres, supermarkets and community centres. Any man with a paunch, or woman with an "apple-shaped" body whose waist measurement is higher than recommended limits is given diet and lifestyle advice or referred to local slimming classes.

Under the scheme the nurses, wearing high-visibility waistcoats, set up portable tables and chairs in town centres to monitor passers-by. If they spot someone who looks overweight they will approach them and strike up a conversation about their health, inviting them to have a "rapid nursing assessment", which includes having their waist measured and their blood pressure checked.

Overweight women can be referred to local Weight Watchers meetings, and men are sent to the NHS Ayrshire and Arran men-only weight loss club 'Slimmin Withoot Wimmin'. Locals can also attend cookery classes where they learn how to prepare healthy meals on a low budget.

I live in a country where government employees are coming up to me in the street and telling me that I look overweight? I mean, what?...

They really don't, do they? Because this is how it begins, whether it's CCTV cameras that tell you off for dropping litter or a spy satellite in the sky, tracking every journey your car makes: a weak attempt at satire on a right-wing blog, usually with some crass reference to Stalin or the Nazis, pops up a year or two later, incredibly, as government pilot scheme, gets 'rolled out' nationally - at galactic expense to John Q. Taxpayer, naturally - and before you know it, there are nurses in hi-vis jackets coming up to you in the street, asking you your waist size and then sending you to - Christ, I can barely type the words, so tightly clenched are my fists with rage - "Slimmin Withoot Wimmin". Well, I'm sorry, but - dear God, I'm repeating myself yet again - mist descending - blood vessels rupturing in my eyeballs - not sure I'm even going to make it to the end of this paragraph - it is none of your GODDAMN BUSINESS. It just isn't, and if there are people out there who honestly and genuinely believe that it is the role of government to walk the streets policing this shit, then we have a real fucking problem here.

The Greek has put it pretty fucking clearly (and do go and read the whole of his piece) but it seems that our government just doesn't fucking get it. But the truth of the matter is that so many people in this country will see nothing wrong with this at all.

They will nod their heads sagely and mutter that it is great that those poor, benighted people who are unable to make their own decisions will be helped towards the path of righteousness by the caring NHS.

They will not realise how incredibly snobbish and condescending their attitude is—"oh, the poor! Yes, I know that one shouldn't stereotype anyone and I, of course, wouldn't dream of doing so but the poor are so terribly stupid, aren't they? It's really our duty to cajole, badger and force them into a healthy lifestyle."

Furthermore, these bien pensant twats do not dream, for one second, that any nurse in a high-viz vest would actually come and start hassling them—no, no, no: this measure is purely for the poor.

"Oh yes," they will twitter at their parties, "I know that I could do with losing a few pounds, but at my time of life...? Besides, a little insulation is healthy, isn't it? And I'm sure that Rubens would have approved!

"Now, have you heard about this wonderful little scheme they've launched in Scotland? Yes, that's right: the one where nurses go and educate poor, fat people in the street. Telling them not to eat so many deep-fried Mars Bars is suppose!" Giggle.

Ha-fucking-ha.

There are a number of posters around Brixton which display the silhouette of a man or woman in profile, with a tape measure around the waist: in the case of the man, the tape measure is at 32 inches and the poster screams that "if your waist is bigger than this, you may need to have a test for diabetes. Go and see your GP."

Thirty-two fucking inches?

Fucking hell: I am about a 32 and I am, as those who know me will testify, definitely on the thin side. Seriously, what the fuck?

These idiot posters are bad enough but one could at least argue that they are attempting to provide information to people. They are irritating but they are a million miles away from the harassment being outlined in Mr E's neck of the woods.

And the British people stand passively on, whilst the government continues in its scheme to make all citizen-units as homogenous as possible. Because, you see, when you are trying to run any system, you want the units to be as near the same as possible; if they are not, they might buck the system.

So the government has been attempting to make the population-units as near identical as possible for ease of control: it has been doing pretty well through the education system, and now they are moving against us with the health system. And the majority of our citizens meekly accept all this.

One looks around and is tempted to use the words that have become Obnoxio's refrain of late: this country is so fucked.

It's surprising how bumptious these people can be. A week or two ago some idiot from the National Statistical Office knocked on my door demanding answers yo some lunatic government survey. I told him to bugger off (politely at first) but he continued asking the questions even after I had closed the door on him!I swear to god in ten years time refusing to cooperate fully with all agents of the collective will become a criminal offence.

If the nurses are also fat (not exactly a million to one shot) are you allowed to point this out without being arrested for a 'hate crime'?

BTW I thought the waist size on the posters was 38". I wouldn't put it past the government to quietly move the goalposts though; they did it with the BMI bands some time ago, the number at which you were considered 'obese' dropped quite significantly some time ago, and hey presto! suddenly there were apparently lots more fat people, panic, crisis, etc.

Or there was the similart govt-engineered panic a couple of years ago about "one in three children being obese". Honestly, walk around the town in which you live, see the evidence (or complete lack of it) with your own eyes.

Part of me is thinking; this is happening in Scotland. In Ayrshire for fuck sake. Don't the NHS realise what people are like round there?But then I start to think, there are plenty of people who will see fuck all wrong with this. Add in the "NHS Angels doing a thankless job" attitude and you might actually see widespread support.

"Fuck off you patronising, meddling, supercillious, useless, pathetic, interfering, ugly, charmless, condescending bitch and in the name of all that is holy mind your own fucking business and never ever attempt to interfere in my life again you stupid, stupid cow."

Take the politics and religion out of all schools. You teach children that they are citizens in a society, you teach them skills based on their abilitiy and you reward effort. You teach them respect. You EDUCATE them.

You reduce politics to a local level. You give real power to real people. You give independents the opportunity to stand as MPs for free. You start letting citizens have control over their own lives, voting directly for how they wish to live. You set a policy of armed neutrality. You reduce the welfare state to a net, not a hammock.

It is not the middle classes that are turning this country into a third world hell hole. Focus your efforts on the 9 million fucktards who either voted ZNL, work for ZNL or are paid danegeld to sit at home and not riot by ZNL

I like the idea that these high visibility waistline cops can in the future break into your home without a warrant and examine the clothes in your wardrobe for "grossness." Expect your trousers to be held up in court as evidence of your wrongdoing.

Trouble is with me saying this, there will be some clown in government who thinks this might be a good idea too.

Not really; smart Britons are fleeing the UK in record numbers because they can see that exit visas will be coming pretty soon and there's little prospect of turning things around in less than a couple of generations.

Now I'm not suggesting that nurses should wear high visibility jackets, unless they are at the scene of a major incident, but there is a flip side to the coin, and it's this........

Try to imagine the bewildered reaction of a patient being told for the first time that, yes, their nagging chest pain, is in fact, due to a small heart attack, or as well as having an abscess they have also developed type II diabetes, or that a persistently painful knee is now so arthritic it will require joint replacement despite the patient being under 50 years of age.

You would have thought that such individuals had carefully considered the implications of their lifestyle choices but still preferred to live on the edge accepting that certain consequences might arise later in life ?

Of course, many individuals anticipate a prospective diagnosis [such as the risk of chronic obstructive airway disease, or heart failure amongst smokers] but a significant proportion still seem completely bemused about the direct relationship between certain illnesses and years of fags, booze, fast food and sedentary life style [at least at the time of diagnosis].

These unfortunate characters might nod in apparent acceptance when being informed of the implications of a specific disease but surprisingly few seem to understand that they have acquired a chronic condition that can only ever be ameliorated [if they are lucky] - some of course die right in front of you after suffering a heart attack or stroke.

In other words isn't prevention better than cure [at least in principle], but libertarian philosophy seems to dictate that no warnings should be issued and that medics should be akin to silent mechanics patching up dysfunctional machinery once it has gone horribly wrong ?

Finally, just a few factoids:Type II diabetes is increasing every year [up by 50% in a decade].10% of children are now clinically obese [BMI 30+]Risk of coronary disease is x3-4 greater if obese.

So tell me Charge Nurse - what's the evidence that this screening exercise meets the criteria to justify screening?

Here are the WHO criteria (not that I'm bigging up that corrupt bunch of wastrels - merely that these are generally accepted rules of screening)

1. The condition should be an important health problem. 2. There should be a treatment for the condition. 3. Facilities for diagnosis and treatment should be available. 4. There should be a latent stage of the disease. 5. There should be a test or examination for the condition. 6.The test should be acceptable to the population. 7.The natural history of the disease should be adequately understood. 8. There should be an agreed policy on who to treat. 9. The total cost of finding a case should be economically balanced in relation to medical expenditure as a whole. 10.Case-finding should be a continuous process, not just a "once and for all" project

9 and 10 are certainly not met by this project. Debate the rest amnogst yourselves. Having high-vis-fat-nanny-nurses in The Forge or Bluewater or The Arndale Centre or wherever is not a cost-effective way of dealing with lard buckets. It is merely a way of the state placing its appartchiks on the street in a pretence that "We're doing something. Look! We care!".

I realise you want to stick up for your own but really, this is no job for any self-respecting nurse.

You are correct Dr Cromarty - as you imply the "evidence" for health promotion leading to vastly improved health outcomes is tentative at best.

But you should also know that A&E bods are almost always presented with fait accompli, in this case the endgame of years of unhealthy eating.

It is also rather naughty of you to suggest that I was trying to 'big up my own' - if you think that then you have rather missed my point.

Let me re-state it for you.I was simply drawing attention to the apparent incomprehension amongst a certain group of patients when the chicken finally come home to roost.

At the time of diagnosis I was simply pointing out that one or two might have acted differently given the dire consequences of diabetes, coronary heart disease, gout, and a host of other chronic conditions is actually affecting them.

Needless to say these unhealthy choices keep my mortgage provider in a state of near rapture, every cloud has a silver lining as they say.

It was 'stick up for' rather than 'big up'. No harm in loyalty, Charge Nurse, and it wasn't really a criticism.

Mrs Cromarty is an A&E consultant so I get to hear about the fait accompli punters all the time. Opportunistic advice is a part of your job ["Given that this is your fifteenth bout of acute coronary syndrome this year, Mr McFuck, your BMI is 38 and you can't walk 5 yards without sitting down, do you think it might be an idea to lay off the pies/ fags/ vodka?"] and does have value. The punter can and often will say "Fuck Off Nursey/Dr Death" but at least they've had the benefit of some sensible advice in an appropriate environment. They make a choice, an informed choice and hopefully accept the consequences.

Swanning about in a luminous jacket outside Woolworths in Ayr like a chugger, badgering fat bastards to stop eating pies merely risks a punch in the face.

What a fucking awful job. And what a fucking awful, nannying, nagging bunch of pollyanna health fascists we have in charge thinking up such a fucking awful job and paying for it with our money.